Study of 40 cases. The blood is rarely absolutely normal in amount of coloring matter and number of red corpuscles during an attack. There is usually a moderate diminution in the limmoglobin and a relatively slighter decrease in the number of red corpuscles; •in other words, the ancemia is chlorotic in type. There is no relation between the severity of the amemia and that of the attack, and when the latter is profound there is usually some complication competent to explain it. Amemia is not an immediate, direct, exciting cause, but frequently a predisposing one. Burr (Pediatrics, Feb. 1, '97).
isTearly all the cases show blood changes and leucocytosis. In a few cases marked increase in the amceboid move ment of the white corpuscles observed and a possible diminution of the eosino phile or orthophiles among the white corpuscles. In all cases the condition of the blood is of great importance in estab lishing a prognosis. In the further study of chorea its Mematology is of the great est importance, and the clinical aspects of the disease point to an infectious ori gin. Loudon (Clin. Med. Rec., Dec., '97).
Two hundred cases of chorea analyzed. One hundred and thirty-six of the pa tients were females and 64 males. After 18 years, 3 cases were found among rnen and 10 among women. Thirty-seven cases occurred after the establishment of the menstrual function and 99 before. A neuropathic heredity and anomalies of the cranium. play an undoubted rale. This nervous heredity was clearly estab lished in 73 cases, of which 49 were in females (with 9 cases of homologous heredity) and 24 in males (with 3 cases of homologous heredity). Anomalies of the cranium were very frequent, most often produced by rachitism, and belong ing to an hydrocephalic type, more rarely to a submicrocephalic type, and more rarely still to a phagiocephalic type. Among other causes responsible for nerv ous predisposition are masturbation, acute diseases, concussion of the brain, and pregnancy. Exciting causes in a cer tain number of cases were articular rheumatism and infectious diseases, in others psychical traumatism. Influence of infectious maladies was manifest in 75 cases; in 58 of these there was acute articular rheumatism, with or without cardiac lesions. Of 75 post-infectious cases a nervous predisposition was pres ent only in 50. In cases in which chorea developed after a psychical traumatism tbe role of neuropathic heredity was much more manifest. Of the 66 eases of
this class such heredity existed in 64 pa tients. Psychical tramnatism most often was of the nature of a fright. In 50 cases the exciting cause could not be as certained. Kraft-Ebing (Wiener klin. Woch., No. 43, '09).
The urine in Sydenham's chorea presents the following characteristics: Diminution of the daily quantity; spe cific gravity relatively high; total acid ity increased; diminution during the disease of the quantity of nitrogen which is not eliininated as urea; in creased elimination of uric acid; de crease in elimination of chlorides: in crease of phosphates; total quantity of sulphuric acid and allied substances, unchanged. De Marchis (La Rifornia Medica, July 5, 1902).
Some cases develop without any dis coverable exciting cause, but in most instances the onset of the chorea is pre ceded by mental strain, worry, or shock of some kind—overwork at school, fear, religious emotion, etc.—or by the occur rence of some infectious disease or tox mmic state, such as rheumatism.
Chorea is a symptom, and not a. dis ease, the principal cause being rheuma tism acting; on a nervous subject. Duck worth (Brooklyn Med. Jour., May, '92). In 134 out of 196 cases of chorea rheu matism was present. In tbe majority of cases chorea is the result of rheumatic diathesis, although cases occur which must be considered as true neuroses. St'e (La, MC;(1. Mod., Oct. 15, 22, '91).
Study of the seasonal relations of chorea and rheumatism for a period of fifteen years. Chorea and rheumatism are periodical, the least severe attacks in chorea occurring in October and _No vember and the most severe in March and April. It is the same in rheumatism. These two affections are considered to have tbe same causal relation with mete orological conditions. Morris Lewis (Boston Med. and Surg. Jour., June 23, '92).
Chorea is nearly always secondary to acute articular rheumatism, or to some infectious disease. An efficient part is played by the mental emotions. ln 19 of 76 cases there was no family history of disease, but an unobserved previous infection suspected. In 14 cases there were cardiac lesions, and in 6 of the 14 the chorea was unmistakably of rheu matic origin; further, there is an etio logical identity between chorea and cn docarditis. Marfan (Revue Mens. des Mal. de l'Enf., Aug., '97).